Provider Demographics
NPI:1750549937
Name:BOWEN, BRITTANY LEANN (LMT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEANN
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WEDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3437
Mailing Address - Country:US
Mailing Address - Phone:432-634-5567
Mailing Address - Fax:432-366-3378
Practice Address - Street 1:1301 WEDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3437
Practice Address - Country:US
Practice Address - Phone:432-634-5567
Practice Address - Fax:432-366-3378
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-24
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT103231225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist